Neurological Assessment

• Neurological observations

  The collection of information that indicate the function and integrity of a patient's central nervous system (brain and spinal cord)
• Consciousness

  A state of general awareness of oneself and the environment
• Altered level of consciousness

  A reduction in alertness or an alteration in behaviour
• Coma

  A totally unconscious and unrousable brain state that results from physical, biochemical and metabolic injuries to the brains arousal mechanisms
• Reticular Activating System (RAS)

  Set of interacting anatomical networks and neurotransmitters found in the pons, midbrain, hypothalamus and thalamus
• Current theory supports that arousal is related to ascending pathways that stimulate the cerebral cortex and are mediated by the thalamus
• Once cortical arousal is achieved, a positive feedback mechanism between the cerebral cortex and the thalamus maintains a wakeful state
• RAS is important in

  • Producing sleep states and awakening mechanisms
• Coma and impaired conscious level

  Any disturbance of normal consciousness indicates brain dysfunction
• Severe GCS Score

  • Severe: GCS 3-8
• AVPU

  Gives information quickly about the patients level of consciousness –then proceed to GCS for a more formal assessment if necessary
• How does the Glasgow Coma Scale help to identify/localise problems?

  Assesses the response generated by different stimuli (auditory and tactile)
• Indications for urgent CT

  • GCS less than 13 at any point since the injury
• Application of painful stimuli-central versus peripheral?

  Peripheral PS could produce a reflex action that has not been interpreted in the higher centres of the brain
• Olfactory Nerve (1)

  • Sensory / Smell
  • Test for odor identification
• Optic Nerve (2)

  • Sensory / Visual Acuity
  • Test for visual acuity
  • Test for visual fields
  • Perform ophthalmologic exam
• Oculomotor (3), Trochlear (4), Abducens (6) Nerves

  • Motor / Eye movement, Pupil Size, Eyelid Opening
  • Inspect eyelids for drooping
  • Inspect pupils for size / equality
  • Test consensual response / accommodation
  • Test extra-ocular eye movements
• Trigeminal Nerve (5)

  • Mixed / Muscle tone, Sensation
  • Inspect face for atrophy / tremors
  • Palpate jaw for tone / strength
  • Test for pain / sensation
  • Test corneal reflex
• Facial Nerve (7)


  • Mixed / Facial Expressions, Taste
  • Inspect facial symmetry
  • Test tongue for salt / sweet
• Acoustic Nerve (8)


  • Sensory / Hearing, Balance
  • Test Hearing
  • Compare bone / air conduction
  • Test for sound lateralization
• Glossopharyngeal Nerve (9)

  • Mixed/ Taste and Swallowing
  • Test tongue for Sour/ Bitter
  • Test gag reflex / swallow
• Vagus Nerve (10)

  • Mixed/ Swallowing, Speech
  • Inspect palate / uvula for symmetry
  • Inspect for swallow difficulty
  • Evaluate guttural speech sounds
• Spinal Accessory Nerve (11)

  • Motor / Muscle Strength
  • Test trapezius / sternocleidomastoid muscle strength
• Hypoglossal Nerve (12)


  • Motor / Tongue strength
  • Inspect tongue for symmetry / tremors / atrophy
  • Test tongue movement
  • Test tongue strength
  • Evaluate lingual speech sounds
• 12 Pairs of Cranial Nerves

  • Olfactory
  • Optic
  • Oculomotor
  • Trochlear
  • Trigeminal
  • Abducens
  • Facial
  • Vestibulocochlear
  • Glossopharyngeal
  • Vagus
  • Accessory
  • Hypoglossal
• Label the neuron

  A) Dendrite

  B) Nucleus

  C) Cell body

  D) Axon Hillock

  E) Mylein Sheath

  F) Node of Ranvier

  G) Schwann Cell

  H) Axon Terminal

  
• Normal ICP range

  0-10
• How long is the REM sleep cycle?

  90 minutes
• Types of delirium

  1. Hyperactive delirium - People with this type may be restless and pace the room. They also may be anxious, have rapid mood swings or see things that aren't there. People with this type often resist care.
  2. Hypoactive delirium - People with this type may be inactive or have reduced activity. They tend to be sluggish or drowsy. They might seem to be in a daze. They don't interact with family or others.
  3. Mixed delirium - Symptoms involve both types of delirium. The person may quickly switch back and forth from being restless and sluggish.
• Which part of the brain controls the HR?

  The pons
• Describe the key functions of the central nervous system

  Guides everyday activities (such as waking up), autonomic activities (such as breathing) and complex processes (such as thinking, reading and feeling emotions.
• Describe the function of the frontal lobe

  • Voluntary movement
  • Expressive language
  • Capacity to plan and control one's responses
• Describe the function of the occipital lobe

  • Visuospatial processing
  • Distance and depth perception
  • Colour determination
• Describe the function of the temporal lobe

  • Processing auditory information
  • Encoding of memory
• Describe the functions of the parietal lobe

  Receiving and processing sensory input (such as tough, heat and pain)
• Describe the function of the cerebellar hemispheres

  • Motor planning
  • Timing of the onset of movements
  • Coordination
• Describe the functions of the brain stem

  Responsible for vital functions of life e.g. breathing, consciousness, blood pressure, heart rate and sleep
• Describe the function of the spinal cord

  Sends motor commands from the brain to the body, sends sensory information from the body to the brain and coordinate reflexes
• Describe the function of the motor cortex

  To generate signals to direct the body’s movement
• Describe the function of the premotor cortex

  Planning and organising movements and actions